Optimal Medical Therapy Prescribing Patterns and Disparities Identified in Patients with Acute Coronary Syndromes at an Academic Medical Center in an Area with High Coronary Heart Disease-Related Mortality
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Coronary heart disease (CHD)-related mortality is high in the southern United States. A five-drug pharmacotherapy regimen for acute coronary syndromes (ACS), defined as optimal medical therapy (OMT), can decrease CHD-related mortality. Studies have indicated that OMT is prescribed 50–60% of the time. Assessment of prescribing could provide insight into the potential etiology of disparate mortality.
The aim was to evaluate prescribing of OMT at discharge in patients presenting with an ACS event at an academic medical center and identify patients at risk of not receiving OMT.
A single-center, retrospective cohort of patients with ACS diagnosis between July 2013 and July 2015 was investigated, and a multivariable regression analysis conducted to identify populations at risk of not receiving OMT.
A total of 864 patients were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes, with 533 excluded and 331 analyzed. OMT was prescribed in 69.79%. Patients ≥ 75 years of age [p = 0.003; odds ratio (OR) 0.30; 95% confidence interval (CI) 0.136–0.673], unstable angina presentation (p = 0.042; OR 0.55; 95% CI 0.307–0.977), and surgical management (p = 0.001; OR 0.22; 95% CI 0.095–0.519) were less likely to receive OMT.
The percentage of patients prescribed OMT exceeded the reported global percentage of prescribed OMT. However, disparities exist among specific populations.
We would like to acknowledge Chelsea LaPreze, Pharm.D., for her contributions to data collection for this project.
Compliance with Ethical Standards
Conflict of interest
Authors Fox, Miller, Skrepnek, Schwier, and Ripley declare they have no potential conflicts of interest that might be relevant to the contents of this manuscript.
No external funding was used in the preparation of this manuscript. None of the authors received grant support or other types of extramural funding for the writing of this manuscript.
- 9.Skrepnek GH, Olvey EL, Sahai A. Econometric approaches in evaluating cost and utilization within pharmacoeconomic analyses. Pharm Policy Law. 2012;14(1):105–22.Google Scholar
- 10.Amsterdam EA, Wenger NK, Brindis RB, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report from the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):2354–94.CrossRefPubMedGoogle Scholar
- 11.O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78–140.CrossRefPubMedGoogle Scholar
- 12.Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1–45.CrossRefPubMedGoogle Scholar
- 17.Bi Y, Gao R, Patel A, et al. Evidence-based medication use among Chinese patients with acute coronary syndromes at the time of hospital discharge and 1 year after hospitalization: results from the Clinical Pathways for Acute Coronary Syndromes in China (CPACS) study. Am Heart J. 2009;157:509–16.CrossRefPubMedGoogle Scholar
- 18.Al-Zakwani I, Zubaid M, Panduranga P, et al. Medication use pattern and predictors for optimal therapy at discharge in 8176 patients with acute coronary syndromes from 6 Middle Eastern countries: data from the gulf registry of acute coronary events. Angiology. 2011;62(6):447–54.CrossRefPubMedGoogle Scholar
- 19.Pfeffer MA, Braunwald E, Moye LA, The SAVE Investigators, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. N Engl J Med. 1992;327(10):669–77.CrossRefPubMedGoogle Scholar
- 24.Tam LM, Fonarow GC, Bhatt DL, et al. Achievement of guideline-concordant care and in-hospital outcomes in patients with coronary artery disease in teaching and nonteaching hospitals: results from get with the guidelines—coronary artery disease program. Circ Cardiovasc Qual Outcomes. 2013;6(1):58–65.CrossRefPubMedGoogle Scholar